<p>FULBRIGHT PROGRAM APPLICATION FOR STUDY IN THE UNITED STATES</p><p>CONFIDENTIAL LETTER OF REFERENCE This letter of reference must be written by a teacher under whom the applicant has studied or pursued research in the proposed field of study or by someone who has supervised the applicant in work related to the proposed field of study. This letter must be typewritten and in English. If not in English, then an accurate translation must be attached. Use the TAB key to move between fields.</p><p>NAME OF APPLICANT COUNTRY </p><p>NAME OF REFEREE </p><p>TITLE </p><p>INSTITUTION OR BUSINESS ADDRESS CITY </p><p>COUNTRY POSTAL CODE </p><p>PHONE NUMBER E-MAIL ADDRESS </p><p>HOW LONG HAVE YOU KNOWN THE APPLICANT? </p><p>IN WHAT CAPACITY HAVE YOU KNOWN THE APPLICANT?</p><p>Employer or Job Other (Please Specify Teacher or Professor Research Adviser Supervisor </p><p>3. IN THIS RATING CHART, PLEASE EVALUATE THE APPLICANT IN COMPARISON WITH OTHER STUDENTS WHOM YOU HAVE KNOWN DURING YOUR POFESSIONAL CAREER.</p><p>Excellent Very Good Average Below Average Not Applicable</p><p>Intellectual Ability</p><p>Knowledge of Field</p><p>Work Habits</p><p>Motivation to Pursue Graduate Study</p><p>Seriousness of Purpose</p><p>Potential For Significant Future Contribution in Field</p><p>Resourcefulness and Initiative</p><p>Emotional Maturity</p><p>Adaptability to New Situations</p><p>Leadership Qualities</p><p>Teaching Potential</p><p>Confidential Letter of Reference Page 1 NAME OF APPLICANT COUNTRY </p><p>CONFIDENTIAL LETTER OF REFERENCE (Continued)</p><p>3. PLEASE PROVIDE A CANDID EVALUATION OF THE APPLICANT’S PAST PERFORMANCE AND ABILITY TO PURSUE AND SUCCESSFULLY COMPLETE A PROGRAM OF STUDY IN THE PROPOSED FIELD. YOUR INFORMATION WILL BE GIVEN CONSIDERABLE IMPORTANCE IN REVIEWING THIS APPLICATION.</p><p>NAME (Print) </p><p>SIGNATURE DATE </p><p>Confidential Letter Reference Page 2</p>